| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
673 |
665 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
889 |
854 |
$23K |
| D1351 |
Sealant - per tooth |
366 |
148 |
$21K |
| D1110 |
Prophylaxis - adult |
544 |
511 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
903 |
870 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
663 |
651 |
$16K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
220 |
162 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,663 |
1,570 |
$10K |
| D0274 |
Bitewings - four radiographic images |
585 |
576 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
403 |
385 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
175 |
140 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
130 |
74 |
$8K |
| D0330 |
Panoramic radiographic image |
203 |
188 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,469 |
1,262 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
306 |
279 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
55 |
49 |
$2K |
| D0270 |
|
369 |
349 |
$2K |
| D0272 |
Bitewings - two radiographic images |
180 |
177 |
$2K |
| D2332 |
|
16 |
15 |
$1K |